Community pharmacist and family medicine clinic provision of chronic care management services for Medicare beneficiaries with uncontrolled hypertension

Abstract

Introduction: Pharmacist-physician collaboration has shown positive results in improving patient outcomes. Chronic care management (CCM) is a reimbursable service for Medicare beneficiaries in the community setting which includes comprehensive care management and other activities. The pharmacist contribution to CCM services and their associated impact on patient health outcomes has not been fully explored.Objectives: The objectives of this study were to: (a) implement a collaborative CCM service between a community pharmacy and family medicine clinic for their common hypertensive patients; (b) measure blood pressure change for patients receiving the CCM intervention; and (c) report financial viability for the community pharmacy and family practice clinic partnership.Methods: Single group prospective pilot intervention in an independent community pharmacy and family medicine clinic in a small city in the Midwest United States.Forty-five patients with uncontrolled hypertension who are patients to both community pharmacy and clinic were recruited, and 26 received CCM interventions in person or over the telephone from the community pharmacists to manage medications for hypertension. Our main outcomes were blood pressure values and financial viability.Results: Twenty-six patients received at least one community pharmacist encounter.These patients had an average 7.3 mm Hg decline (P = .006) in systolic blood pressure (SBP) and a 2.4 mm Hg decline (P = .079) in diastolic blood pressure (DBP) at 9 months. The total revenue over the study period was $5842. Total revenue for the community pharmacy and clinic was $2785 and $3057, respectively. Conclusion:The community pharmacy/clinic collaboration resulted in improved blood pressure control, a new source of revenue for the community pharmacy, and increased revenue for the clinic. Further research is needed on CCM revenue sharing between physicians and pharmacists to generalize the results.

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

“…Medication adherence based on the medication possession ratio was significantly higher among the CMM group (CMM = 0.811 vs. usual care = 0.659, p < 0.005), and the CMM group subjects were more likely to switch therapy when indicated (24.2% vs. 5.4%, p = 0.001) 28 . A prospective single group prestudy and poststudy of hybrid CMM found improvement in systolic blood pressure (133 mmHg vs 140 mmHg, p = 0.006), but no change in diastolic blood pressure at 9 months 30 . Another single‐center prepilot and postpilot study of CMM via telehealth on a patient‐aligned care team noted a 2% reduction from baseline A1c at 6 months ( p = 0.0002; Table 4).…”

“…All studies included a pharmacist and a provider on their team conducting the interventions 23‐33 . The number of interprofessional team members delivering CMM varied from two to five members.…”

“…Pharmacists made recommended medication changes in real‐time using collaborative practice agreements in seven studies 24,27‐30,32,33 and made real‐time recommendations to the provider in four studies 23,25,26,31 . Six studies studied interventions that used telehealth to reach patients 24,26,27,31‐33 whereas five studied interventions using a hybrid model (combination of telehealth and face‐to‐face delivery) of care 23,25,28‐30 . Seven studies offered audio‐only telephone outreach, 23,24,26,28‐31,33 four used two‐way audio–video connections, 25,27,31,32 and one also used secure text messaging (Table 2).…”

“…Five studies reported objective clinical outcomes 23,24,28,30,32 . One RCT comparing a pharmacist‐physician collaborative care model using a telehealth/in‐person hybrid model to provide usual care over 12 months among a diabetes population found a greater reduction in A1c from baseline (CMM = −0.79% vs. usual care = −0.16%, p = 0.010), higher adherence based on the Morisky‐Green test (12 vs. −2, p < 0.001), no change in reduction in diastolic blood pressure (−6.3 vs. −3.2 mmHg, p = 0.300), no change in systolic blood pressure reduction (−12.5 vs. −4.4 mmHg, p = 0.071), and no change in low‐density lipoprotein reduction (−10.2 vs. −12.2 mg/dl, p = 0.768) even with a high prevalence of chronic disease 23 .…”

“…As Bosworth et al 24 studied a broader population, improvement in diabetes may not have been discovered in their smaller subset of diabetes studies with no detected improvements. When comparing telehealth CMM with baseline patient characteristics (predesign and postdesign), one study found statistically significant reductions in blood pressure, 30 but another study by Maxwell et al 32 found no difference in blood pressure, a difference that may be accounted by the fact that Hoehns et al 30 enrolled patients with an average uncontrolled blood pressure at baseline and Maxwell's patient population did not 32 . Nevertheless, A1c improved significantly from baseline 32 .…”